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Effect of Short-Course, High-Dose Amoxicillin Therapy on Resistant Pneumococcal Carriage: A Randomized Trial
Abstract
CONTEXT: Emerging drug resistance threatens the effectiveness of existing therapies for pneumococcal infections. Modifying the dose and duration of antibiotic therapy may limit the spread of resistant pneumococci. OBJECTIVE: To determine whether short-course, high-dose amoxicillin therapy reduces risk of posttreatment resistant pneumococcal carriage among children with respiratory tract infections. DESIGN AND SETTING: Randomized trial conducted in an outpatient clinic in Santo Domingo, Dominican Republic, October 1999 through July 2000. PARTICIPANTS: Children aged 6 to 59 months who were receiving antibiotic prescriptions for respiratory tract illness (n = 795). INTERVENTIONS: Children were randomly assigned to receive 1 of 2 twice-daily regimens of amoxicillin: 90 mg/kg per day for 5 days (n = 398) or 40 mg/kg per day for 10 days (n = 397). MAIN OUTCOME MEASURES: Penicillin-nonsusceptible Streptococcus pneumoniae carriage, assessed in nasopharyngeal specimens collected at days 0, 5, 10, and 28; baseline risk factors for nonsusceptible pneumococcal carriage; and adherence to regimen, compared between the 2 groups. RESULTS: At the day 28 visit, risk of penicillin-nonsusceptible pneumococcal carriage was significantly lower in the short-course, high-dose group (24%) compared with the standard-course group (32%); relative risk (RR), 0.77; 95% confidence interval (CI), 0.60-0.97; P =.03; risk of trimethoprim-sulfamethoxazole nonsusceptibility was also lower in the short-course, high-dose group (RR, 0.77; 95% CI, 0.58-1.03; P =.08). The protective effect of short-course, high-dose therapy was stronger in households with 3 or more children (RR, 0.72; 95% CI, 0.52-0.98). Adherence to treatment was higher in the short-course, high-dose group (82% vs 74%; P =.02). CONCLUSION: Short-course, high-dose outpatient antibiotic therapy appears promising as an intervention to minimize the impact of antibiotic use on the spread of drug-resistant pneumococci.
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Citations
Cited by
Costelloe, C., Metcalfe, C., Lovering, A., Mant, D., & Hay, A. D. (2010) · BMJ · doi:10.1136/bmj.c2096 · Cited by 1,981
Bell, B. G., Schellevis, F., Stobberingh, E., Goossens, H., & Pringle, M. (2014) · BMC Infectious Diseases · doi:10.1186/1471-2334-14-13 · Cited by 1,262
Antimicrobial Use and Antimicrobial Resistance: A Population Perspective
Lipsitch, M., & Samore, M. H. (2002) · Emerging Infectious Diseases · doi:10.3201/eid0804.010312 · Cited by 497
Antimicrobial-resistant bacteria in the community setting
Furuya, E. Y., & Lowy, F. D. (2006) · Nature Reviews Microbiology · doi:10.1038/nrmicro1325 · Cited by 386
Moussaoui, R. E., de Borgie, C. A. J. M., van den Broek, P., Hustinx, W. N., Bresser, P., van den Berk, G. E. L., Poley, J.-W., van den Berg, B., Krouwels, F. H., Bonten, M. J. M., et al. (2006) · BMJ · doi:10.1136/bmj.332.7554.1355 · Cited by 339
Metadata
- Authors
- Schrag, S. J., Peña, C., Fernández, J., Sánchez, J., Gómez, V., Pérez, E., Feris, J. M., & Besser, R. E.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2001-07-04
- Volume
- 286
- Issue
- 1
- Pages
- 49
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W1986602388
- Cited by
- 233
- References
- 0
- FWCI
- 14.02
- Type
- journal article
- Language
- en
- Open access
- closed
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- Schrag, S. J., Peña, C., Fernández, J., Sánchez, J., Gómez, V., Pérez, E., Feris, J. M., & Besser, R. E. (2001). Effect of Short-Course, High-Dose Amoxicillin Therapy on Resistant Pneumococcal Carriage: A Randomized Trial. JAMA. https://doi.org/10.1001/jama.286.1.49
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